15 - Mental Health Flashcards

Question

What are some symptoms of hyponatraemia and which people are high risk for developing this when taking SSRIs?

Answer 1

- dizziness, drowsiness, confusion, nausea, muscle cramps, or seizures - need to stop antidepressants if this happens

Answer 2

**Chronic, excessive worry for at least 6 months** which is not related to particular circumstances/difficult to control, and **symptoms of physiological arousal** such as restlessness, insomnia, and muscle tension Some people present with obvious anxiety but some have just somatic symptoms e.g headaches, muscle tension, gastrointestinal symptoms, back pain, and insomnia

Answer 3

**_DSM-5:_** - At least 6 months of excessive, difficult to control worry about everyday issues on more days than not - Worry is not confined to another medical condition/mental disorder e.g substance abuse - 3 of the following: restlessness/nervousness, being easily fatigued, poor concentration, irritability, muscle tension, or sleep disturbance **_ICD-10_** - Anxiety which is generalized and persistent, not just in particular situations - Expression of fears such as that the person or a relative will shortly become ill or have an accident - Symptoms including persistent nervousness, trembling, muscle tension, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort

Answer 4

- Female - FHx - Current physical or emotional stress. - History of physical or emotional trauma. - History of other anxiety disorders such as panic disorder, social phobia, or specific phobias. - Chronic pain or physical illness (such as arthritis, cancer, COPD) - History of substance abuse - Repeated visits with the same physical symptoms which do not respond to treatment - Medications like salbutamol, theophylline, beta-blockers, herbal medicines (St. John's wort) and some antidepressants

Answer 5

- Other anxiety disroders e.g anorexia nervosa, PTSD, OCD, adjustment disorder - Medication-induced anxiety - Hyperthyroidism - IBS - Cardiac or Pulmonary disease - Phaeochromocytoma (anxiety with HTN and/or tachycardia) - Anaemia

Answer 6

- TFTs to rule out hyperthyroidism - Urine drug screen - 24-hour urine for vanillylmandelic and metanephrines to rule of phaeochromocytoma - ECG - Pulmonary function tests

Answer 7

Chronic, fluctuating, remitting and relapsing disorder that generally requires long-term treatment 12 week trial of pharmacotherapy and if effective continue for up to 12 months

Answer 8

**GAD may recur** under physical or emotional stress **Depression co-ocurs in 50%** of patients with GAD and increases the risk of suicidality With pharmacotherapy and 6-8 sessions of psychotherapy symptoms can remit for a while

Answer 9

Stress often due to an external origin and stops when the stressor is removed Anxiety is an internal origin and does not stop when a stressor is removed

Answer 10

- Scores of 5, 10, and 15 are taken as cut-off points for mild, moderate, and severe anxiety respectively - Symptoms in the past 2 weeks

Answer 11

- Examine signs e.g tremor, increased startle response, tachycardia, SOB - Consider differentials - GAD7 - Assess suicide risk and risk of comorbid depression

Answer 12

**_Step 1: All GAD patients_** - Assess the severity with GAD7 - Enquire about emotional stressors, substance abuse, medical conditions etc - Provide written info about GAD and treatment options (PILS) - Active monitoring of symptoms/treatment **Step 2: For people without marked functional impairment who have not improved following step 1** - Individual non-facilitated self-help - Individual guided self-help (Alice materials and 20 min calls) - Psychoeducational groups **Step 3: For people with functional impairment or who have not improved since step 2** - High intensity psychological intervention OR - Drug treatment with first line SSRI reviewing every 2-4 weeks for first 3/12 then every 3/12 e.g ***sertraline, paroxetine, escitalopram or duloxetine, venlafaxine*** In under 30s review in first week and weekly for first month due to risk of suicide **_Step 4_** - Refer for specialist treatment if at risk of suicide or self harm or self neglect or other treatments haven't worked - Do not offer benzos, these are for short term crises

Answer 13

Dealing with overwhelming problems in a more positive way by breaking them down into smaller parts

Answer 14

**Sleep hygeine**: getting up and sleeping at same time, no alcohol after 6, no caffeine after 3, get out of bed if cannot sleep, no TV, no daytime naps **- Benefits of regular exercise** **- Self help books** **- Mindfulness**

Answer 15

Try to only use if benefits outweigh risks e.g birth defects etc **- Duloxetine** - Sertraline (can cause cardiac defects, neonatal withdrawal if used near to term, persistent pulmonary hypertension) - Citalopram (SSRI pregnancy risk)

Answer 16

- Depression - Suicide - Substance abuse Anxiety is a chronic condition!!!

Answer 17

Fluoxetine!!!!!

Answer 18

Measures cognitive impairment and can be used as an adjunct for dementia 24-30 No cognitive impairment 18-23 Mild cognitive impairment \<18 Severe cognitive impairment Below 21 increased odds of dementia

Answer 19

**Screening tool for dementia** using a patient and an informant questionnaire. Scores on image If informant questionnaire needed a **score of 3/6** or more suggests **cognitive impairment** **Informant questionnaire asks how patient differs from now and 5-10 years ago** e.g using wrong words, memory, recollecting conversations, less able to manage money, unable to manage meds, more assistance needed with transport

Answer 20

- Really important to assess with depressed patients - Strongest risk factor is a history of self harm - Mental illness (particularly depression), male, unemployed, living alone, physical health problems, exposure to suicidal behaviour, substance misuse, F Hx **Precipitating factors:** stressful events that can trigger suicide in vulnerable people like divorce, death of a loved one, finacial problems

Answer 21

- Social support - Religious belief - Being responsible for children (especially young) - Connectedness to other adults - Easy access to mental health support e.g doctors - Self esteem and a sense of meaning/purpose to life

Answer 22

- Open and careful questions e. g 'some people who are very low think about taking their own life, have you ever thought anything like this? - See image for more

Answer 23

- Talked about feeling hopeless or trapped - Acting anxious, agitated or reckless - Withdrawing from friends and family - Displaying extreme mood swings - Talking about wanting to die or looking for a way to kill theirself

Answer 24

- If **actively suicidal** keep them in the surgery or with a family member and call the **CRISIS team** or try **voluntary admission** or **section under MHA** - If **risk of suicide** but no intent then encourage patient to talk to **family/support systems and inform them of support networks** like **Samaritans**. - Assess any dynamic risk factors e.g substance abuse, mental health disorders. to be treated - Tell patient to seek help if situation deteriorates - Review patient frequently, especially after starting pharmacological treatment. Record in notes. Give patient out of hours number.

Answer 25

If doing something morally good has a morally bad side effect it is ethically ok to do this if the bad side effect was not intended. Can foree the bad side effect e.g morphine for palliative care

Answer 26

**Personality disorder** Take seriously as increased risk of suicide long term

Answer 27

**_Suicide_** - Samaritans - Shout - Papryus - 111 - Calm - Mind **_Suicide consequences_** - Help is at Hand - Healthtalk online: bereavment due to suicide - SAVE

Answer 28

- Intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act, and is an expression of emotional distress. - Most self poisoning due to OTC drugs, other household substances, or plant material - Most self injury is cutting - Can also include suicide attempts

Answer 29

- Socioeconomic disadvantage - Social isolation - Stressful life events, e.g divorce, childhood abuse - Mental and physical health problems - Alcohol or drug misuse People who self harm then increase their risk of committing suicide

Answer 30

- If child always keep overnight and obtain parental consent before assessment. Remove all means to self harm from child e.g drugs - If over the age of 65 all self harms should be considered to have suicidal intent until proven otherwise

Answer 31

- Given advice regarding: **self management of superficial injuries** (e.g tissue adhesive), **harm minimisation** techniques, offerred **alternative coping strategies**, how best to **deal with scarring** - Harm minimisation strategies should not be offered if self harming by poisoning

Answer 32

- **Refer to A and E** and consider patient's welfare on transportation - If urgent care not necessary consider referring to **secondary mental health services** at earliest opportunity **following psychological assessment** for risk of suicide and other mental health disorders e.g depression - Prescribe drugs to these patients in **small doses** and favour **low toxicity drug**s and also to relatives living with someone at risk of self poisoning

Answer 33

- Prisoners - Asylum seekers - Veterans - LGBT - Groups who self harm together Usually in young people aged 15-25!!

Answer 34

- Third party may bring them in as they notices unexplained injuries, inappropriate dressing, depressive symptoms, weight/diet change, substance misuse - May be found incidentally on examination for another medical problem

Answer 35

**- Treat OD** (e.g activate charcoal within hour to reduce absorption) or cuts and wounds **- Analgesia/anaesthesia** when treatin and sedation if any treatment will evoke distressing memories e.g repairing genital area **- Assess mental capacity** and conduct **psychosocial assessment** alone with patient. If too distressed or difficult due to drug OD then temporary admission and then perform at earliest convienience. Pass to GP and file clearly in notes - Relatives/cares should be **offered emotional support** **https://geekymedics.com/wp-content/uploads/2020/08/OSCE-Checklist-Suicide-Risk-Assessment.pdf**

Answer 36

- Consult the TOXBASE app to find initial treatments and consult on the phone with the nearest ED

Answer 37

- Care plan and risk management care plan - Manage any associated mental health conditions e.g bipolar, depression, drug misuse etc. Take into consideration toxicity (SSRIs low but TCAs high risk of toxicity) - Refer for any psychological interventions necessary e.g CBT, group therapy

Answer 38

- Use clean instruments - Think about wound aftercare - Avoid major arteries, veins and tendons and go for soft, fleshy parts - Cut down the depth and the time spent harming - 5 minute rule to wait to self-harm and think about not wanting the scars or to go to hospital - Put stickers on areas you want to injure - Draw slashing lines on paper - Snap elastic band on wrist - Use red food colouring to mimic blood

Answer 39

- Occurs **after an unexpected life crisis** e.g a serious accident or sudden bereavement, sexual assault, domestic violence - Develop few minutes or hours after event and can last days-weeks. **\>1 month then assess for PTSD** - **Not usually treated** as passes on its own but if prolonged can offer **CBT, counselling, beta-blockers** for physical symptoms, **short term diazepam**

Answer 40

Five stages of grief after the death of a loved one - Denial - Anger - Bargaining - Depression - Acceptance

Answer 41

- Rely on support network of family and friends - Speak to a grief counsellor e.g **Cruse** - Contact support groups e.g Loss Foundation, Child Bereavment UK

Answer 42

**Anorexia:** low body weight due to restriction of food intake or persistent behaviour which interferes with weight gain and intense fear of gaining weight **Bulimia:** recurrent episodes of uncontrolled eating of an abnormally large amount of food over a short time period (binge eating) followed by compensatory behaviour such as self-induced vomiting, laxative abuse or excessive exercise Use the **SCOFF questionnaire** to assess and also assess mental health, general obs, muscle tone with squat and sit, risk of refeeding syndrome, BMI, social history e.g bullying, look for electrolyte abnormalities and ECG

Answer 43

- Relationship problems e.g lack of attraction/trust - Sexual problems e.g vaginal dryness, vaginismus, ED - Stress, anxiety, exhaustion - Depression - Menopause - Pregnancy and breastfeeding - Long term health conditions e.g heart disease, thyroid, diabetes - Alcohol and drugs

Answer 44

Anxiety disorder where intrusive thoughts (obsessions) lead to rituals (compulsions) to neutralise the obsessions **Presentation:** obsessions and/or compulsions that cause marked distress, are time consuming (take more than 1 hour per day), or interfere substantially with the person's normal routine, occupational or academic functioning, or usual social activities or relationships **Treatment (1st Line):** CBT with exposure and response prevention, alone or in combination with an SSRI or clomipramine

Answer 45

**- Stress** e.g job, relationship, finances - **Psychiatric comorbidity** e.g GAD, depression, PTSD - **Medication** e.g antidepressants, steroids, nicotine, caffeine, drug withdrawal, antihypertensives, NSAIDs **- Medical comorbidity** e.g BPH, pain, perimenopausal symptoms, Alzheimers **- Poor sleep hygeine and environment**

Answer 46

**Assessment**: physical and psychological assessment for underlying cause, sleep diaries, polysomnography **Management:** sleep hygeine advice, CBT through IAPT, pharmacological treatment **Pharmacology:** short term benzos and Z drugs, short term melatonin, antidepressants, sedating antipsychotics and antihistamines

Answer 47

- Increased risk of depression and anxiety - Risk of absenteeism, accidents at work and road accidents are increased - Increased risk of HTN

Answer 48

1. Understand information relevant to the decision 2. Retain information relevant to the decision 3. Use or weigh the information 4. Communicate decision

Answer 49

6 months to 2 years